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Comparison of different views with three-dimensional echocardiography: apical views offer superior visualization compared with parasternal and subcostal views
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2008 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 28, no 6, 409-416 p.Article in journal (Refereed) Published
Abstract [en]

Studies seeking to validate real-time three-dimensional echocardiography (3DE) with regard to cardiac function and dimensions have almost exclusively used apical views. However, it has never been examined whether apical views are preferable to parasternal or subcostal views. In the present study, we compared the feasibility of 3DE volumetric measurements of the four heart chambers in three different views. We included 40 patients planned for a routine two-dimensional transthoracic echocardiography examination (2DE). All patients were scanned with both 2DE and 3DE (Sonos 7500; Philips Medical Systems Andover, MA, USA). Parasternal, apical and subcostal views were used for 3DE. Volumes were calculated using manual tracing in 16 planes. 2DE was performed in parasternal longaxis, subcostal and apical four- and two-chamber views. Manual tracing was used for area calculations. To be judged fully traceable, 5/6 (85%) or more of the ventricular and atrial walls had to be adequately visualized in each plane. The left ventricle and left atrium were adequately visualized in the 3DE apical view in 34 (85%) and 40 (100%) patients, respectively. Visualization of the right atrium was adequate in 31 (78%) patients, whereas the right ventricle was adequately visualized in only 12 (30%) patients. The apical view of 3DE provided superior visualization of all four heart chambers compared with the parasternal and subcostal views, when applying a slight off-axis approach for both ventricles when needed. Thus, in the present study, there was no incremental value of assessment of chamber volumes in the parasternal and subcostal views.

Place, publisher, year, edition, pages
2008. Vol. 28, no 6, 409-416 p.
Keyword [en]
adult, 3DE, echocardiography, heart volumes, human, left atrium, left ventricle, right atrium, right ventricle, standard view, LEFT ATRIAL VOLUME, LEFT-VENTRICULAR VOLUMES, MAGNETIC-RESONANCE, EJECTION FRACTION, 2-DIMENSIONAL ECHOCARDIOGRAPHY, 3D ECHOCARDIOGRAPHY, DATA-ACQUISITION, VALIDATION, SIZE, ACCURACY
URN: urn:nbn:se:kth:diva-12960DOI: 10.1111/j.1475-097X.2008.00823.xISI: 000260049400009OAI: diva2:319893
QC20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2010-06-29Bibliographically approved
In thesis
1. Assessment of Left Ventricular Function and Hemodynamics Using Three-dimensional Echocardiography
Open this publication in new window or tab >>Assessment of Left Ventricular Function and Hemodynamics Using Three-dimensional Echocardiography
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Left ventricular (LV) volumes and ejection fraction (EF) are important predictors of cardiac morbidity and mortality. LV volumes provide valuable prognostic information which isparticularly useful in the selection of therapy or determination of the optimal time for surgery. Two-dimensional (2D) echocardiography is the most widely used non-invasive method forassessment of cardiac function, 2D echocardiography has however several limitations inmeasuring LV volumes and EF since the formulas for quantifications are based on geometricalassumptions. Three-dimensional (3D) echocardiography has been available for almost twodecades, although the use of this modality has not gained wide spread acceptance. 3D echocardiography can overcome the above mentioned limitation in LV volume and EF evaluation since it is not based on geometrical assumption. 3D echocardiography has been shownin several studies to be more accurate and reproducible with low inter- and intraobservervariability in comparison to 2D echocardiography regarding the measurements of LV volumesand EF.

The overall aim of the thesis was to evaluate the feasibility and accuracy of 3D echocardiography based-methods in the clinical context.

In Study I the feasibility of 3D echocardiography was investigated for determination of LV volumes and EF using parasternal, apical and subcostal approaches. The study demonstrated that the apical 3D echocardiography view offers superior visualization.

Study II tested the possibility of creating flow-volume loops to differentiate patients with valvular abnormalities from normal subjects. There were significant differences in the pattern from flow-volume loops clearly separating the groups.

In Study III the visual estimation, “eyeballing” of EF was evaluated with two- and tri-plane echocardiography in comparison to quantitative 3D echocardiography. The study confirmed that an experienced echocardiographer can, with a high level of agreement estimate EF both with two- and tri-plane echocardiography.

Study IV exposed the high accuracy of stroke volume and cardiac output determination using a3D biplane technique by planimetrically tracing the left ventricular outflow tract and indicating that an assumption of circular left ventricular outflow tract is not reliable.

In Study V, two 3D echocardiography modalities, single-beat and four-beat ECG-gated 3D echocardiography were evaluated in patients having sinus rhythm and atrial fibrillation. Thesingle-beat technique showed significantly lower inter-and intraobserver variability in LV volumes and EF measurements in patients having atrial fibrillation in comparison to four-beat ECG-gated acquisition due to absence of stitching artifact.

All studies demonstrated good results suggesting 3D echocardiography to be a feasible andaccurate method in daily clinical settings.

Place, publisher, year, edition, pages
Stockholm: KTH, 2010. xvi, 52 p.
Trita-STH : report, ISSN 1653-3836 ; 2010:2
Three-dimensional echocardiography, heart chambers, flow-volume loop, left ventricular ejection fraction, visualization, left ventricular stroke volume, left ventricular outflow tract, and single-heartbeat
National Category
Biomedical Laboratory Science/Technology
urn:nbn:se:kth:diva-12966 (URN)978-91-7415-621-8 (ISBN)
Public defence
2010-06-04, Huddinge sjukhus, lokal C1-87, Stockholm, 09:00 (English)
degree of Medical Doctor QC 20100629Available from: 2010-05-20 Created: 2010-05-20 Last updated: 2010-12-07Bibliographically approved

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